MANAGEMENT OF PRE-ECLAMPSIA AND

ECLAMPSIA

Jan, Akbar: JPMI, Vol 14 June 2012

Introduction

Spinal
Anesthes
ia

Hypoten
sion

Phenylephri
ne
or
Ephedrine

Aim Of The Study

Recognizing and managing preeclampsia and eclampsia patient to

reduce maternal and fetal mortality

Study Design

Review article journal

Statistical analysis: Fisher exact
test, Newcombes method,
Microsoft Excel version 14.1.4

 Prophylactic boluses of
ephedrine 10 mg IV
(intrathecal block)
Rescue boluses of 5 mg
ephedrine (BP < 90 mmHg)

Prophylactic boluses of 100

g phenylephrine
(intrathecal block)
Rescue boluses of 50 g
phenylephrine (BP < 90mm
Hg)

Group 1

Group 2

Materials and Methods

Methods
Inclusion Criteria
ASA Grade I patients
undergoing elective

Exclusion Criteria
Pregnancy induced
hypertension

cesarean section

History of Diabetes

under spinal

Cardiovascular and

anesthesia with a
normal singleton
pregnancy beyond
36 weeks gestation

cerebro vascular disease

Fetal abnormalities
Contraindication to spinal
anesthesia

Place and Time

Place: Lions Gate Hospital, North

Vancouver, British Columbia, Canada
Time: December 2010 to September
2011

Materials and Method

Approval of Institute ethical
committee and written informed
consent
100 ASA grade I patients (match the
inclusion and exclusion criteria)
Premedication: Oral ranitidine 150
mg on the evening before and 2
hours pre op with a sip of water

Materials and Method

MONITO
R

STANDARD MONITORING
HR & BP

Preloaded with 10 ml/kg of normal

saline Lateral/ sitting position
25 gauge Quinckes needle in
L3-L4
2.5 ml of 0.5 % Bupivacaine
(10-15 seconds)
Supine position
Spinal
anesthesia
Phenylephrine 100 g IV bolus
or Ephedrine 10 mg IV bolus
BP and heart rate were
recorded 2 minutes before the
delivery, 5 minutes after
Neonatal outcome (APGAR
score and neonatal umbilical
chord)

IV
CANNULA

Result

Result

Result

Result

Result

Result

Discussion

the incidence of adverse respiratory

events is not lessened when a 1:1 singlesyringe mixture of ketamine and
propofol is used compared with using
propofol alone

incidence of respiratory adverse events

is associated with both the total dose
and the rate of administration of
propofol

Discussion

offset any protective effect provided by

the reduction in total propofol dosage

When propofol alone is used, deep

sedation can be achieved with doses of 1
to 2 mg/kg,45,46 whereas dissociative
sedation with ketamine monotherapy
usually requires 1.0 to 1.5 mg/kg

Discussion

ketofol procedural sedation results in

more consistent depth of sedation
compared with propofol sedation

the incidence of other nonrespiratory

adverse events was low in both groups

Conclusion of the study

Ketofol for ED procedural sedation does

not result in a reduced incidence of
adverse respiratory events compared
with propofol alone.
Induction time, efficacy, and sedation
time were similar; however, sedation
depth appeared to be more consistent
with ketofol

Critical Appraisals
P

100 ASA grade I patients undergoing elective

cesarean section under spinal anesthesia

I
C
O

Phenylephrine
Ephedrine

Efficacy in preventing and treating hypotension

 India
2008-2010
100 ASA grade I patients
undergoing elective cesarean
section under spinal anesthesia
Prospective double blind
randomized controlled study

Place

Time
Sample
Design

Critical Appraisals

THERAPY WORKSHEET
Are the results of this single preventive or
therapeutic trial valid?
Was the assignment of patients
to treatments randomised?
Was the randomisation list
concealed?

Yes

Was follow-up of patients

sufficiently long and complete?

Yes

Were the groups similar at the

start of the trial?

Yes

Were patients and clinicians kept

blind to treatment?

Yes

Were the groups treated equally,

apart from the experimental
treatment?

Yes

Will the results help me in caring for

my patient ? (External
Validity/Applicability)
Is my patient so different to those
in the study that the results
cannot apply?

NO

Is the treatment feasible in my

setting?

YES

Will the potential benefits of

treatment outweigh the potential
harms of treatment for my
patient?

YES

RECOMMENDATION

Valid
and
applica
ble

THANK
YOU